Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $13.80 / $13.80	Facility	26	$13.80	$13.80	$13.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.19 / $33.19 / $33.19	Facility	TC	$33.19	$33.19	$33.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.22 / $47.25 / $75.06	Professional		$40.22	$47.25	$75.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.93 / $15.33 / $60.52	Professional	26	$11.93	$15.33	$60.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.29 / $33.19 / $94.34	Professional	TC	$28.29	$33.19	$94.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $103.94 / $129.93	Professional		$85.01	$103.94	$129.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.74 / $30.25 / $37.82	Professional	26	$24.74	$30.25	$37.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.27 / $73.69 / $92.11	Professional	TC	$60.27	$73.69	$92.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $81.94 / $314.00	Professional		$52.52	$81.94	$314.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $17.48 / $26.96 / $107.32	Professional	26	$17.48	$26.96	$107.32
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.77 / $54.98 / $296.00	Professional	TC	$33.77	$54.98	$296.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $53.14 / $53.14 / $53.14	Facility	26	$53.14	$53.14	$53.14
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $102.49 / $102.49 / $102.49	Facility	TC	$102.49	$102.49	$102.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.00 / $96.49 / $111.69	Professional		$87.00	$96.49	$111.69
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $54.06 / $73.69 / $86.68	Professional		$54.06	$73.69	$86.68
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $18.34 / $22.70 / $28.70	Professional	26	$18.34	$22.70	$28.70
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $34.02 / $45.42 / $60.81	Professional	TC	$34.02	$45.42	$60.81
United Facility/Professional Professional Modifier Low / Median / High Price $53.15 / $73.04 / $91.30	Professional		$53.15	$73.04	$91.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.98 / $26.96 / $35.02	Professional	26	$15.98	$26.96	$35.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $43.20 / $56.28	Professional	TC	$35.40	$43.20	$56.28
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $76.50 / $90.00 / $90.00	Professional		$76.50	$90.00	$90.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.80 / $26.90 / $26.90	Professional	26	$22.80	$26.90	$26.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $63.10 / $63.10	Professional	TC	$53.70	$63.10	$63.10